Late Progression of Tricuspid Regurgitation After Transcatheter Aortic Valve Replacement

Few studies have investigated the progression of baseline mild or less tricuspid regurgitation (TR) after transcatheter aortic valve replacement (TAVR). The aim of this study was to investigate the prevalence and predictors of late progression of baseline mild or less TR and the impact of late progression on outcomes after TAVR.

We reviewed 1615 patients who had baseline mild or less TR and 1-year echocardiographic follow-up registered in the Optimized Catheter Valvular Intervention-Transcatheter Aortic Valve Implantation registry. We compared outcomes including 2-year all-cause mortality, cardiac mortality, and heart failure hospitalization between groups with and without progression of TR on 1-year transthoracic echocardiography (TTE) and investigated predictors of progression of TR after TAVR.

On 1-year TTE, TR worsened to a moderate or severe grade in 87 patients (5.4%). The group with TR progression had higher 2-year all-cause mortality, cardiac mortality, and heart failure hospitalization than the group without TR progression. The multivariable analysis showed that TR progression was significantly associated with all-cause mortality (hazard ratio, 4.08; 95% CI, 1.92-8.67; P < .001) and heart failure hospitalization (hazard ratio, 2.85; 95% CI, 1.64-4.93; P < .001). Independent predictors of TR progression included atrial fibrillation, transaortic mean pressure gradient <40 ​mm Hg on pre-TAVR TTE, and systolic pulmonary artery pressure ≥40 ​mm Hg.

TR progression from mild or less to moderate or severe after TAVR was more likely observed in patients with low transaortic gradients, atrial fibrillation, or pulmonary hypertension. TR progression after TAVR was associated with increased all-cause mortality and heart failure hospitalization.